The Duty to Extend the “Biological Warranty Period” (Part 3)

Recall the context for Singer's argument- Avoidable suffering and death are bad. There is a moral duty to provide food, shelter or medical care which can prevent suffering and death. And Singer invokes the following principle, which I shall refer to simply as DA (duty to aid):

If it is in our power to prevent something very bad from happening, without thereby sacrificing anything else morally significant, we ought, morally, to do it.

[note: There is a stronger version of the principle, which stipulates "without thereby sacrificing anything of comparable moral importance..." but that does not concern me here, so I will refer simply to the weaker version of DA]

I believe Singer’s principle must be analyzed further, so that an ambiguity concerning how it is employed at the operational level can be rectified. This ambiguity stems from the fact that the applied examples Singer invokes, such as saving a drowning child and providing food and shelter for the poor, are both examples that involve protecting humans from extrinsic factors which cause suffering and premature death. But focusing only on extrinsic factors leads to a limited moral perspective, one where DA is conceived of as only aspiring to prevent the harms of extrinsic factors. But there are also intrinsic factors which cause (avoidable) disability, disease and death. And some of these intrinsic factors account for an increasing amount of the suffering and death in the world given the significant improvements that have been made with material prosperity, sanitation, etc. over the past century (and since Singer first wrote his paper in 1971). For this reason it is prudent to critically examine how DA ought to be addressed at the operational-level in an aging world.

Broadly speaking, there are three different causes of the kinds of harm (i.e. preventable suffering and death) DA seeks to mitigate. There are harms that arise from extrinsic factors, harms that arise from intrinsic factors, and harms that arise because of a combination of extrinsic and intrinsic factors.

Extrinsic factors are those typical of the world’s hostile environment. For example, infectious diseases like smallpox and malaria, natural disasters (e.g. hurricanes), violence and scarcity of resources. But there are also intrinsic factors, such as our biological design, which make our bodies and minds less resistant to various kinds of stress over time (this is called biological aging or senescence). Understanding the evolutionary and life history of our species is thus vital to appreciating the origins of these kinds of intrinsic harms.

Many instances of disease and death are a combination of both intrinsic and extrinsic factors. Take, for example, poverty. It is easy to assume that all the causes of malnutrition stem from extrinsic factors, like lack of food. A person that does not have amble food will be malnourished, and thus vulnerable to disease and suffering and, eventually, death. But, strictly speaking, this explanation is only part of the story of our vulnerability to starvation. There are also intrinsic factors at play. Not every mammal will die if they go weeks, even months, without food. Bears, for example, can survive prolonged periods of time without food when they hibernate. So what determines the nourishment requirements humans need to stay healthy and alive? Why can’t humans be sustained by more infrequent access to food? The biology of homo sapiens in thus implicated, to some (non trivial) degree, in the story of our vulnerability to starvation in the world. If humans had the ability to slow down their metabolism, as animals that hibernate can, they could reduce the expenditure of energy when food is scarce. But humans do no have this biological capability. We have basic material needs that must be met frequently (i.e. almost daily). And these nutritional demands mean that we risk malnourishment, even starvation, when the supply of food is not steady. The metabolism we have today is a result of our species' evolutionary and life history.

The fact that humans have the biology we have means that we must consume a certain level of calories and nutrients consistently in order to survive. This intrinsic factor can result in death when food is in short supply. By the same token, if the reason food is in short supply stems from the fact that there was a drought, or misguided public policies were implemented to oversee the creation and distribution of food, then these extrinsic factors are also part of the explanation of the cause poverty and malnourishment.

While we can make a conceptual distinction between external and intrinsic factors, both factors are typically at play when describing the cause of disease and death. One might wonder why it is even worth bringing up the intrinsic factors at play in the story of human malnourishment. Am I suggesting we could re-design the human metabolism? No. But actually considering such a case could be instructive. So let us do that now.

To illustrate the significance of identifying the different causes of avoidable suffering and disease, when it comes to the operational level of DA, consider the following purely hypothetical and fanciful scenario. Suppose that, while Singer was writing in 1971, a new drug had just been developed that safely and effectively re-programmed the metabolism of the human body. By simply taking one (inexpensive) pill a day, the food and drink a person consumed would automatically be converted into the nutrients typical of a healthy, balanced diet regardless of the quantity and quality of provisions consumed. So consuming even just a few minimum grains of rice and some water could, when taken in conjunction with this metabolic drug, be equivalent to consuming the nourishment provided by eating a balanced diet composed of fruits and vegetables, meat and bread.

Furthermore, imagine also that the person taking this pill in conjunction with minimal amounts of food and water would not feel any hunger pains after taking this pill. So the psychological, as well as physiological effects, of eating a balanced and healthy diet would also be realized. Suppose this scientific discovery occurred on the eve of Singer completing his paper “Famine, Affluence and Morality". Would he have reason to edit and revise his paper before sending it off for publication? I think he would.

It would be odd to invoke DA and insist that those living in affluent countries donate money only to charities which would ship food half way across the world to impoverished nations if there was another, more efficient and effective, way to prevent the bad of poverty. DA does not prejudge what constitutes the most effective way to prevent the bad of avoidable suffering and death. It merely instructs us to prevent something bad from happening when we can prevent this bad, without sacrificing something of moral significance. Assuming the drug in question was truly safe and effective, the provision and distribution of such a pill could be a more effective way of combating the harms of poverty than trying to redress all the extrinsic factors at play with food provision (e.g. drought, floods, war, agricultural infrastructure, etc.). Such a pill would be viewed as "a medicine" which protects against malnourishment. And if we could prevent suffering and death by providing this pill to the world's poor then we ought to do so.

What this example suggests is that DA should be sensitive not only to the costs or burdens associated with fulfilling DA, but also to the probability that different kinds of interventions to prevent harm will be successful. When it comes to malnourishment we tend to think the provision of food is the central strategy for combating poverty because it redresses one extrinsic factor (namely, the shortage of food). But of course eliminating poverty is vastly more complex and challenging that making food available. 40 years after the publication of Singer's article millions of people still live in poverty, despite enormous humanitarian efforts to eradicate poverty. Could we do more? Yes. But poverty persists not only because of a lack of "political will", but also because of a lack of knowledge concerning the most effective ways of mitigating poverty in the long term. Our knowledge has improved since 1972, but there is still much work that needs to be done.

To bring the likelihood of success to the fore our of reflections at the operational level of DA, we can modify DA in the following manner:

DA: If it is in our power to prevent something very bad from happening, without thereby sacrificing anything else morally significant, we ought, morally, to do it. The cause of this suffering and death could be extrinsic and/or intrinsic factors, but these causes themselves have no moral relevance to the stringency of the duty to aid. What is relevant, however, are the costs and likelihood of success in preventing suffering and death. When aspiring to implement the duty to aid consideration must be given to such empirical complexities.

What does this modified version of DA give us? I think its main benefit is that it compels us to consider the full range of ways we could prevent disease and death. More specifically, it opens the door to identifying the evolutionary causes of disease in late life as something that should be mitigated (and might possibly be mitigated by an "anti-aging" pill that mimics calorie restriction or activates the "longevity genes"). More on that later.